Provider Demographics
NPI:1306802590
Name:WURTZ, RICHARD (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:WURTZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ALOHA DR
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-4639
Mailing Address - Country:US
Mailing Address - Phone:310-880-8011
Mailing Address - Fax:
Practice Address - Street 1:1 ALOHA DR
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-4639
Practice Address - Country:US
Practice Address - Phone:310-880-8011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34446122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist